Provider Demographics
NPI:1518077635
Name:SLOAN, GREG KEITH (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:KEITH
Last Name:SLOAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-4360
Mailing Address - Country:US
Mailing Address - Phone:850-638-9399
Mailing Address - Fax:850-638-3720
Practice Address - Street 1:925 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-4360
Practice Address - Country:US
Practice Address - Phone:850-638-9399
Practice Address - Fax:850-638-3720
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20064OtherBLUE CROSS
FL067951800Medicaid
FL20064Medicare ID - Type Unspecified
FL067951800Medicaid